Cardiotoxicity and cardiac arrhythmias in cancer therapy: a review of current evidence

Cardiac arrhythmias are among the most frequent and clinically significant manifestations of anticancer therapy-induced cardiotoxicity. Despite substantial progress in oncology and the increasing availability of targeted and immunological treatments, the incidence of cardiovascular complications, including rhythm disturbances, continues to rise. This article provides a comprehensive review of current evidence on the association between various types of anticancer therapies — including traditional cytotoxic chemotherapy, targeted therapies, immune checkpoint inhibitors, Chimeric antigen receptor T-cell therapy, and Bispecific T-cell engager therapy — and the development of arrhythmias. Special attention is given to pathophysiological mechanisms, including direct cardiomyocyte toxicity, electrophysiological disturbances due to ion channel blockade, ischemic myocardial injury, and inflammatory changes. The review outlines the clinical manifestations of common arrhythmias such as atrial fibrillation, ventricular tachycardia and atrioventricular block caused by different classes of anticancer drugs. Additionally, it discusses modern approaches to the diagnosis, screening, and prevention of arrhythmic complications in patients with cancer. A key emphasis is placed on the importance of a multidisciplinary approach involving close collaboration among cardiologists, oncologists, and clinical pharmacists to optimize treatment safety and efficacy while preventing potentially life-threatening conditions. Finally, the article highlights the need for further research into molecular mechanisms and the development of standardized monitoring algorithms in patients undergoing anticancer therapy, including the application of digital health technologies and artificial intelligence.